General Inspection: Contusion

LUMP EXAMINATION
Introduction
A lump is a protuberance or localized area of swelling that can occur anywhere on the body.
Other terms used to describe the various types of lumps include bump, nodule, contusion, tumor
and cyst. Lumps can be caused by any number of conditions, including infections, inflammation,
tumors or trauma. Depending on the cause, lumps may be single or multiple, soft or firm, painful
or painless. They may grow rapidly or may not change in size.
Lumps due to local infectious causes may appear as boils or abscesses. Many types of infections
cause the lymph nodes to enlarge and feel like lumps, most commonly in the neck, near the
jawbone, in the armpits, or in the groin. Traumatic causes of lumps range from bug bites to
severe injuries that can produce a localized collection of blood in the tissues (hematoma).
Both benign and malignant tumors of the skin, soft tissues, or organs can sometimes feel like
lumps. In these cases, either a biopsy or surgical removal of the lump can determine whether
cancer is present. Cysts, which are fluid-filled, sac-like structures that can form in various parts
of the body, often feel like lumps. Some cysts may be present at birth, while others develop as a
result of inflammation, tumors, or wear-and-tear over time.
Conditions that produce inflammation throughout the body, such as rheumatoid arthritis, may be
associated with lumps. Lumps located in the thyroid gland may cause symptoms related to
hormonal imbalance, including rapid heart rate, sweating, restlessness, and weight loss.
Lumps caused by infection, inflammation or trauma are usually temporary and subside as the
underlying condition resolves. Lumps that persist or continue to grow over time may signal more
serious conditions such as tumors. A lump on the head that is associated with an injury may
signal bleeding in the brain or another emergency and may have life-threatening complications.
General Inspection
 Note any evidence of pain (e.g. stance/grimacing)
 Note the patient’s overall colour (e.g. pallor secondary to anaemia or jaundice)
 Note any evidence of abdominal distension (may suggest bowel obstruction, possibly due
to an incarcerated hernia)
 Note any muscle wasting or cachexia suggestive of underlying malignancy
 Look around the bed for evidence of vomit bowels or medication boxes
Close Inspection
Site
 Be precise (e.g. mid-point of the inguinal canal)

 If there are multiple lumps, this is more suggestive of superficial lymph nodes, superficial
lesions (e.g. lipoma) or dermatological problems (e.g. large skin lesions)
Size
 Use a tape measure if available (otherwise, a shortcut is to measure and memorise the
length of the distal phalanx of your index finger, and use that as a reference)
Shape
 This refers to the whole outline of the lump (e.g. round/oval/irregular/well-defined)
Colour
 Is the lump a different colour from the surrounding skin (e.g. erythematous)?
Contour
 This refers to the look and texture of the skin overlying the lump
 Is it same as rest of the skin, or thick/rough/scaly/smooth/shiny?
Palpation
Tenderness
 Press on the lump and look at the patient’s face to see if they grimace
 Ask the patient if the lump is painful
 Is the whole lump tender or just a part of it?

Temperature
 Palpate the temperature using the back of your hand, comparing to surrounding tissue
 Significantly increased temperature suggests infection (e.g. abscess) and will normally be
associated with erythema
Consistency
 Comment whether the lump is hard, firm, soft or nodular

 Hard corresponds to the feel of your forehead, firm to the tip of your nose, and soft to
your lip
Tethering
 Is the lump freely mobile, or is it tethered to a structure such as skin or muscle?

 Malignant lumps are often fixed to surrounding tissue
Pulsatility
 Is the lump pulsatile?

 Pulsatility suggests underlying vascular aetiology (e.g. an aneurysm)
Lymphadenopathy
 Palpate the lymph nodes that drain the area the lump is located within (commonly the
inguinal lymph nodes are assessed when an inguinal hernia is suspected)
 Lymphadenopathy surrounding the lump suggests either infective or malignant aetiology
Auscultation
Bruit
 Auscultate the lump for a bruit (suggestive of vascular aetiology)

 Listen for bowel sounds and if present, it suggests the lump contains bowel (e.g. as is
often the case in a hernia)

Other tests
Compressibility
 This test should only be used for suspected hernias

 Check it the lump can be compressed (a.k.a reduced)
 You can ask the patient to do this, or do it yourself
 If the lump can be reduced completely, it may only reappear if the patient increases
pressure (e.g. by coughing)
 You can ask the patient to lie down and if the lump reduces spontaneously, this makes the
diagnosis of a hernia highly likely
 Hernias are typically reducible, however, if a hernia is painful and irreducible it suggests
that it is strangulated (this is a surgical emergency)
Cough impulse
 This test should be used for suspected hernias

 Ask the patient to cough whilst you palpate the lump
 A positive cough impulse occurs when you see and/or feel the lump increase in size when
the patient coughs
 A cough impulse indicates a communication between the intra-abdominal cavity and the
lump (e.g. a hernia)
Transillumination
 Ideally dim the lights in the room first

 Shine a light through the lump and see if it illuminates
 Transillumination suggests that the lump is cystic (e.g. hydrocoele)

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LUMP EXAMINATION

 Be precise (e.g. mid-point of the inguinal canal)

 This refers to the whole outline of the lump (e.g. round/oval/irregular/well-defined)

 Comment whether the lump is hard, firm, soft or nodular

 Is the lump freely mobile, or is it tethered to a structure such as skin or muscle?

 Is the lump pulsatile?

 Auscultate the lump for a bruit (suggestive of vascular aetiology)

 This test should only be used for suspected hernias

 This test should be used for suspected hernias

 Ideally dim the lights in the room first

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